注意力不足過動症兒童之平衡功能

The Balance Function of Children with Attention Deficit/ Hyperactivity Disorder

注意力缺損過動症（Attention-Deficit/ Hyperactivity Disorder, 簡稱過動症）在學齡兒童的盛行率是3-5%。過動兒除了主要症狀如注意力缺陷、過動及衝動外，亦常伴有平衡及動作協調的問題，但是這方面的實証研究尚十分缺乏。本研究的主要目的即在探討過動兒童的靜態與動態平衡及動作反應能力，以深入了解其動作控制是否有缺陷。實驗組為15名五到九歲，經醫師診斷為過動兒，其家長填答之孩童活動量表分數達百分等級八十五之孩童，對照組為14名年齡介於五到九歲的一般孩童。使用SMART電腦平衡測定系統（SMART Balance Master System, Version 6.0）評估兩組孩童睜眼或閉眼站在堅硬的平面或海棉墊上的平衡能力，以及在力板上執行由坐到站、行走、快速轉身、踏過一個八吋高的台階等活動之穩定度。此外，並使用電腦反應系統（REACTOR）評量孩童依螢幕之指示，向前、後、左、右四個方向雙腳跳的反應速度，轉位時間及回復平衡所需之時間。分析評量結果發現過動兒在靜態平衡能力及動作反應能力兩方面比一般孩童要差，尤其在反應速度方面，過動兒的反應未能夠因跳的方向不同、難易度不同而有所差別，對照組之一般孩童則隨方向的不同其表現有明顯的差異。在動態活動方面的表現則兩組沒有明顯的不同。這些結果顯示，過動兒主要在需要精細控制的靜態平衡方面較有困難，其動作反應能力亦不似對照組孩童成熟。進一步蒐集較大樣本數，並針對精細動作之控制探討，將可進一步驗證本研究之發現。

The prevalence of Attention-Deficit/Hyperactivity Disorder (ADHD) is estimated at 3%-5% in school-aged children. In addition to the prominent problems such as attention deficit, hyperactivity and impulsivity, children with ADHD usually also exhibit difficulties in balance and coordination. However, very few research studies on this topic were done in the past. The purpose of this study was to investigate the static and dynamic balance abilities and motor reaction of children with ADHD to understand the extent of motor control problems in this population and their nature. Fifteen 5 to 9 year-old children with a diagnosis of ADHD with activity level of 85 percentile or greater as rated by their parents were included in the experimental group. Fourteen typically developing children of similar age without any diagnoses were recruited as the comparison group. SMART Balance Master System (Version 6.0) was used to measure the static and dynamic balance of children of the two groups. The measurements included 1) the ability to maintain balance when standing on a firm surface or a foam with eyes open or closed, respectively and 2) the stability in sit-to-stand, walking, taking two steps then making a turn quickly and returning to start position, and stepping up/over an eight inch curb. Motor reaction of the children was measured by REACTOR. Children had to jump to the front, back, right or left according to the instruction shown on a screen. Reaction time, transit time and stabilization time were recorded. The results showed that children with ADHD had poorer performance than their comparison group on static balance and motor reaction, especially on reaction time. Unlike the children in comparison group, children with ADHD did not differ significantly in their reaction time across directions or levels of challenge. However, there was no significant difference in the dynamic motor performance between the two groups. The results of this study suggested that the motor problems of children with ADHD might be mainly in static balance that requires fine motor control. The motor response of children with ADHD in this study was not as mature as that of typically developing children. Future research with larger sample size and focusing on fine motor control is needed to verify this finding.